Enrollment time: Experts offer ways to save on health insurance

November 11, 2013|By Marni Jameson, Orlando Sentinel

Many employees weighing their health-insurance options during open enrollment are looking for ways to shave costs.

But too many don't give enough thought to one of the most important decisions they can make for themselves and their families, said Elizabeth Calzadilla-Fiallo, spokeswoman for UnitedHealthcare's Florida and Gulf States region.

For starters, they should consider changes that might be coming next year: a baby, braces, elective surgery?

"People need to pay attention to their individual reality. That's why there are an array of plans out there," Calzadilla-Fiallo said.

How to save on health care:

•Scale back your plan. Choice comes with a price, said Jon Urbanek, Florida Blue senior vice president for commercial markets. A PPO plan (for preferred-provider network) or a POS plan (for point of service) will offer the widest choice of providers, but you will pay more for that. An HMO (for health-maintenance organization) will have a narrower provider network and will cost less. But if your doctors are in that network, you could save a lot going with an HMO plan. A newer plan type now available in Florida is the High Performing Network. These offer an even more limited choice of providers for an even lower cost. Check each year to make sure your doctor still participates in your health plan's network, said Dr. Michael Howell, Cigna's senior medical director for Florida.

Trend: Today's HMOs don't have the same huge restrictions that made them unpopular years ago, said Urbanek, causing them to gain favor now with employees. "New technology and better coordination of care has made these plans much better."

•Increase your deductibles and co-pays. This is another trade-off, but you can come out way ahead if you opt for plans with higher deductibles and co-pays, because premiums will drop a lot, Urbanek said. "If you don't go to the doctor much, you may be better off with a higher-deductible plan and a lower premium," he said. But don't stop there. Also look for ways to save within the plans. For instance, some plans have a low co-pay for emergency-room visits. But if you don't think you'll use the ER, you could save by going with a plan that has a high ER co-pay. Similarly, if you're unlikely to be a hospital patient, opt for a lower-premium plan that has a higher co-pay for inpatient days. Among Florida Blue members, 75 percent of surgeries were outpatient, spokesman Mark Wright said.

Trend: "To save money, more consumers are taking a catastrophic view of health care," Urbanek said. "They know they will pay more if there's a serious problem and are taking their chances."

•Factor in your prescriptions. If you can switch to the generic version of medication you're taking, that will bring a huge cost savings, Urbanek said. Next, check each plan's drug-coverage policy for your specific medications and compare them. Coverage can vary widely, so drug costs need to be evaluated on a case-by-case basis.

Trend: "Patients used to be skeptical about generics," Urbanek said, "but not anymore." Five years ago fewer than 60 percent of patients went with generics. Today more than 90 percent do, he said.

•Revisit vision and dental. Many consumers don't realize that vision and dental plans don't provide insurance so much as assistance. If no one on your plan needs glasses, you probably don't need a vision plan, which is for eye exams and eyewear. Dental plans mostly cover cleanings, fillings and some orthodontia. Dental and vision plans typically cost about $1 a day combined per person, said UnitedHealthcare's Calzadilla-Fiallo. Consider how much $365 could buy you in vision and dental care. Remember, if you have an eye injury or a dental accident, chances are your medical plan would provide coverage.

Trend: Some consumers are opting to purchase vision coverage every other year. They could have an eye exam this December and get eyewear if needed, then not buy a plan again until 2015.

•Consider a health savings plan. HSA accounts as well as flexible spending accounts allow employees to deposit pretax dollars into an account and draw on the money to pay for qualified medical expenses, including co-pays and prescription drugs. A key difference is that HSAs let you roll unused funds into future years, while FSA funds go away at the end of the year.

Trend: The use of HSA accounts is growing fast, Urbanek said. Calzadilla-Fiallo agrees: "In the last year, we saw consumers continuing to move to HSA and leaner benefit plans to help offset premium increases."

•Ask about wellness programs. Some plans offer incentive-based wellness programs that provide financial rewards for completing health assessments, lowering your cholesterol, losing weight, stopping smoking or even signing up for a health-coaching program. Taking care of your own health is always the best way to keep health costs down.